The Journal of Bone and Joint Surgery (American). 2005;87:508-513.
doi:10.2106/JBJS.D.02193
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Staggered Bilateral Total Knee Arthroplasty Performed Four to Seven Days Apart During a Single Hospitalization

Christopher D. Sliva, MD1, John J. Callaghan, MD1, Devon D. Goetz, MD2 and Stephen G. Taylor, MD2

1 Department of Orthopaedics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for J.J. Callaghan: john-callaghan{at}uiowa.edu
2 Des Moines Orthopaedic Surgeons, Des Moines Methodist Hospital, 6001 Westown Parkway, West Des Moines, IA 50266

Investigation performed at the Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, and Des Moines Methodist Hospital, Des Moines, Iowa

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from DePuy. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (DePuy) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The purpose of this study was to evaluate the types and prevalence of complications associated with bilateral total knee replacement performed four to seven days apart during a single hospitalization and to compare them with those associated with bilateral knee replacement performed sequentially under the same anesthetic session or staged unilateral replacements performed during separate hospitalizations.

Methods: Using a computerized database and medical records, we retrospectively evaluated 332 consecutive patients who underwent bilateral total knee replacement performed by two surgeons. A total of 241 patients underwent staggered bilateral knee replacement with the procedures performed four to seven days apart during one hospitalization, twenty-six underwent sequential bilateral total knee replacement, and sixty-five underwent staged bilateral knee replacement performed during two separate hospitalizations. The data on major complications, including death, return to operating room, myocardial infarction, and pulmonary embolism, and on minor complications, including atrial fibrillation, deep-vein thrombosis, and urinary tract infection, were evaluated.

Results: Patients undergoing sequential bilateral total knee replacement and staged bilateral knee replacement had an overall rate of complications that was 2.5 times higher than that of the staggered group. Major complications were rare in all groups, but they occurred most often in the staged bilateral replacement group. The overall rate of complications for the patients who had staggered bilateral knee replacement (13%) was significantly less (p = 0.0009) than that for the patients who had sequential bilateral knee replacement (35%) or staged bilateral knee replacement (31%). The length of inpatient stay for those with staggered total knee arthroplasty was four days longer than that for the sequential arthroplasty group (p = 0.0001).

Conclusions: Staggered bilateral total knee replacement, with the procedures performed four to seven days apart in a single hospitalization, is a safe and practical method for performing bilateral total knee replacement.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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J. Barrett, J. A. Baron, E. Losina, J. Wright, N. N. Mahomed, and J. N. Katz
Bilateral Total Knee Replacement: Staging and Pulmonary Embolism
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Staggered Bilateral TKA Performed Four to Seven Days Apart During a Single Hospitalization
Bertrand P Kaper
JBJS Online, 13 Jun 2005 [Full text]
Editor's Note
Robert Poss, MD
JBJS Online, 13 Jun 2005 [Full text]